See the small space between the ball acromium? That is where the impingement happens. Making sure the supraspinatus tendon, which pushes the ball down as the arm bone is lifted by the deltoid, is working well is a big part of the picture of shoulder healthy function. BUT….if you raise the shoulder blade UP by STRENGTHENING the muscles which lift it up, (such as serratus anterior) and STRETCH muscles which PULL it down (such as latissimus dorsi) you can gain more space, which puts less pressure and pinch on the supraspinatus tendon.

serratus muscle upwardly rotates the shoulder blade

latissimus dorsi pulls shoulder blade down

http://comstockpt.com/2011/11/22/neck-pain-stretches-out-olympia-wa/ This link will show you some latissimus stretches, and if you refer to Part 1 in this series of blog posts, with the man leaning against the wall you can see how to strengthen the serratus anterior

More about how the shoulder blade works with the shoulder and how bad shoulder girdle strength can cause shoulder impingement. The image and movie clip below show shoulder blade elevation, with the actress in the video showing LESS elevation and upward rotation on the left than the right.

The space between the ball (humeral head) and the shelf above (acromium) which sits on the shoulder blade is where impingement of one or two of the rotator cuff tendons happens (supraspinatus or infrapinatus).
Here is an image of a normal shoulder and one with impingement:

normal shoulder anatomy

shoulder pain caused by impingement

If the shoulder blade is hanging low (like the one on the left in the video) the space for the tendon is a lot smaller. So doing shoulder blade strengthening exercises to elevate the shoulder blades will help with shoulder blade pain itself.

Okay, today we are discussing a very sensitive issue–Pelvic Health Physical Therapy. Having pelvic health issues can be intimidating–because, it is soooo personal. You may be wondering, what issues do people suffer that have poor pelvic health?

Lots of problems can happen down south. There are muscles in the pelvic floor (the levator ani aka pelvic floor muscles or PF) PF muscles can spasm or become weak, just like shoulder muscles, or any other muscle groups. The difference with these muscles causing problems, however, is that spasms here can cause other problems with how the pelvic organs function. Stress incontinence (leakage when you lift, cough, sneeze, run) can happen, often in women but also in men who have had prostate cancer surgery, from weakness.

Levator ani muscles, otherwise know as Pelvic Floor muscles

Urge and frequency incontinence happens when the bladder muscles decide it is time for your bladder to let go, even if You don’t think it is time, and then… you leak. Medicine can be helpful for urgency and frequency, but they leave you with dry mouth side effects.

These muscles can also spasm causing a lot of pain and difficulty with fully emptying your bladder.

A lot of other pelvic health conditions can be treated by pelvic floor physical therapy…more tomorrow

People often wonder, if I go to physical therapy will it hurt? Sometimes I’ve heard people say “PT” stands for “pain and torture.”

So, does physical therapy hurt? This is the good news: most of the time the answer is NO!

When will physical therapy hurt? Once in a while the answer is yes, BUT that is because of the surgery you have had and the steps that you need to go through to get past the normal side effects of having a surgery. What surgeries will be more painful to rehabilitate from? In my experience as a physical therapist, new knee replacements seem to be the most painful. Second to that is shoulder surgery. The worse pain is usually there for a while only then gets better as you recover and move more, usually within a few weeks to a month.

When should physical therapy be comfortable? Most of the time physical therapy should be comfortable and make you feel better as each treatment progresses. The old adage of “no pain no gain” does NOT apply. When you have an injury, working weak muscles until they are tired will be a good limit of exercise; if you push past the muscle you are working feeling tired (heavy and achey) you might cause more pain because your body is working in its weak zone and that is when more pain happens.

Will there be soreness after my physical therapy session? It is pretty common for patients to feel sore after their PT appointment, especially your first visit because we have to have you move a lot to fully evaluate your problem. Sometimes after introducing a new exercise, or increasing resistance you will be sore too. You should not be in pain, however and if your soreness is there for more than 1-2 days, speak up on your next PT session because that is too long.

Most of the time physical therapy should be comfortable and leave you feeling good!

Here is an interesting case of a patient who injured her right knee with a cartilage tear about 15 months ago.

Her hip responded to the right knee injury by twisting in at the thigh and out at the shin. The angle between the upper leg and lower leg is about 25 degrees, and on the left, her normal leg is about 10 degrees.

After one treatment, and some home exercises her knee looked like this: